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Dualistic Thinking and Prophecy (COVID update, 12 March 2020)

Before the numbers, a question: Is the COVID19 pandemic a crisis, or not? In the US how you answer that seems to break along political lines. But the answer isn’t really a simple “yes” or “no,” and that is a source of conflict and confusion in a society that demands simple, sound bite style answers that hopefully break down along party lines. In many instances, the question “is or is not” (“to be or not to be” as some English dude wrote) is the wrong question. The Buddhists call this “dualistic thinking”. In the COVID crisis, the answer to the question above is a firm “it depends.”

The short version (and you know the longer version is below!) is that this is not a crisis for the vast majority of people. Even if you get it, it’s not as bad as many of the influenza strains going around. HOWEVER: if you are in a vulnerable population, it is as much as 10 times deadlier than the flu. In addition, because of the rapid progression, lack of immunity, and severe respiratory distress of patients who present for treatment, it is a potential catastrophe for our health care system, which does not have the capacity to deal with this. Thus the contradiction and conflict: for most people it’s not a big deal, but for the health care system it risks overload, and for vulnerable populations, it’s deadly. So how do you balance all that, prepare, but not scare people and wreck the economy? Clearly, not how we’re doing things at the moment …

So here is where we are: If you look at the progression in Hubei, the hospitalization rate is converging to about 0.12% based on the data as of yesterday (11 March 2020). In Korea it is virtually identical – 0.11% (which is why I “trust” the China numbers, with reservations). The mortality rate for those hospitalized is 4.5% in Hubei and 0.77% in Korea. Why the big difference? Much better health care system and more aggressive intervention.

In Italy expect to see the numbers continue to climb in a scary way for a the next week. They are “only” at a 0.06% hospitalization rate. Iran is also only about halfway into the progression, based on Hubei/ROK (and supplemented with the data from the Diamond Princess “petri dish”). Italy’s mortality rate for hospitalized cases is about 6.2% – a lot higher than Hubei. Why? I suspect two reasons. First, it is an older population. Second, I suspect the China numbers are not including all of the early deaths. So there is still a lot of “upside” to the Italy numbers, and the European cases and fatalities will continue to “skyrocket,” but no need to panic: this is expected and fits the progression.

The scary thing about Italy is what this indicates is possible here in the US. Using the available data, the US can expect approximately 380,000 people requiring hospitalization, and about 20,000 deaths. That sounds like a huge number – but it isn’t. The 2017 H3N2 influenza outbreak hospitalized 810,000 and killed 61,000. HOWEVER those were spread out over a whole season, and the fraction of cases requiring ICU care was smaller, so while it caused a lot of strain on the health care system (largely unnoticed by the public) it wasn’t as bad as COVID19 is likely to be. The next couple of months will be rough.

On Economics: for what it’s worth, I think the travel ban with Europe is a waste of time at this point, and causing far more economic harm than medical good. I’m rather surprised the administration is doing it. The time to implement that kind of travel restriction was over a month ago. It’s probably pointless now; the virus is here, and spreading. A few more cases from outside aren’t going to make much difference, and the economic harm is significant. What we are seeing in the economy is a mix of COVID19 fear, a needed correction in the markets, internal turmoil in the oil markets, and issues related to the already distorted credit markets. It’s complicated – but COVID is the trigger that has caused underlying structural problems to surface.

So what does all that mean to you? In short, same as it ever was: Wash your hands, don’t touch your face, don’t freak out. The best source of practical information is at the CDC web site, and the DHS/FEMA “ready.gov” pandemic preparation site. Essentially, these are common sense actions. But here are a couple of things to emphasize: If you or a member of your family is over 65 (and especially over 75), or has health problems (especially respiratory or immune system issues), you should take some extra precautions. Avoid crowds, limit travel where you will be exposed to people, be super-fastidious about hygiene, and so forth, until this thing subsides, hopefully in a few months. If you have family in the hospital or long term care facility (or living on their own for that matter) you may need to hold off visiting for a while. Call often, make sure they are OK, and that they understand why this needs to be. Some other suggestions are to get a good thermometer (the no-touch ones are getting reasonably priced, just make sure it is reliable), and build a “baseline” temperature profile for your family. 98.6F is the accepted average, but that may not be your number. A two degree above normal temperature is considered a fever. My “normal” temperature is around a degree lower than that, so if I’m at 99.6, I’m running a two degree temperature and something’s up. (PS – I’m not, I’m a cool 97.4F this morning 😛 ).

Finally, a warning: you are hearing a lot of really scary numbers and projections. Many of these are out of context or just plain wrong (like Dr. Fauci’s “10% mortality rate” quote), and people are doing forecasts that are way out on the far end of the probability curve. Take some advice from Saint Augustine: